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Lancet Critiques India’s ‘Endgame’ Approach to the Pandemic

The Lancet dissects the COVID emergency in India, what led to it and what can help de-escalate it.

Updated
Coronavirus
3 min read
<div class="paragraphs"><p>India's response to the&nbsp; COVID crisis has been less than satisfactory.</p></div>
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In early March, Union Health Minister Harsh Vardhan declared India's victory over COVID saying that the pandemic was in the 'endgame'.

This was only a few weeks before the second covid wave—more devastating than the first—gripped the nation.

In its editorial this week, The Lancet, writes, "as of 4 May, more than 202 Lakh cases of COVID-19 have been reported in the country with an average of 3,78,000 cases a day, together with more than 2,22,000 deaths", numbers that are believed to be an underestimation of the actual numbers.

They go on to illustrate the grim scenes of death and desperation from across the nation.

"Hospitals are overwhelmed, and health workers are exhausted and becoming infected," it reads.

Social media is full of desperate people (doctors and the public) seeking medical oxygen, hospital beds, and other necessities
The Lancet

But, what led us to this point when we were celebrating the 'end of the pandemic' just a few weeks ago?

Faulty Data and a False Sense of Security

The oped comes down heavily on the Government's initial laxity as the number of infections started dipping earlier this year.

"The impression from the government was that India had beaten COVID-19 after several months of low case counts, despite repeated warnings of the dangers of a second wave and the emergence of new strains," it reads.

It goes on to talk about how it was falsely suggested that India had reached herd immunity, which further led to complacency and insufficient preparation.

The serosurvey conducted by the Indian Council of Medical Research in January, however, suggested that only 21% of the population had antibodies against SARS-CoV-2.

But, the general attitude was that of compliance, with COVID thought to be on its way out. This is further evident from the fact that before April, the National COVID task force had not met in months.

The crisis that followed turned out to be disproportionately more devastating to some states.

The Repercussions of the Slackness

“With states like Uttar Pradesh and Maharashtra unprepared for the sudden spike in cases, (these states) started quickly running out of medical oxygen, hospital space, and overwhelming the capacity of cremation sites.”
the Lancet

It further talks about how this message of COVID being in 'endgame' also led to the slowing down of India's COVID-19 vaccination campaign, the inoculation plans soon falling apart.

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“The government abruptly shifted course without discussing the change in policy with states, expanding vaccination to everyone older than 18 years, draining supplies, and creating mass confusion and a market for vaccine doses in which states and hospital systems competed.”
the Lancet

While some states struggled to bolster their health care facilities against the mounting infections, other states, like Kerala and Odisha, that were better prepared were able to produce enough medical oxygen in this second wave to support themselves and other states.

Going Forth: What Can Help?

The Institute for Health Metrics and Evaluation estimates that India will see a staggering 1 million deaths from COVID-19 by Aug 1.

But if these numbers are to be avoided the oped recommends India would need a 'two-pronged strategy'.

  • By salvaging what left of the vaccination campaign, and rationalise and implement it optimally.

  • Reducing SARS-CoV-2 transmission as much as possible while the vaccine is rolled out.

  • By expanding Genome sequencing to better track, understand, and control emerging and more transmissible SARS-CoV-2 variants

“As cases continue to mount, the government must publish accurate data in a timely manner, and forthrightly explain to the public what is happening and what is needed to bend the epidemic curve, including the possibility of a new federal lockdown.”
The Lancet
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It speaks of the essential role that the central government plays in explaining to the public the necessity of masking, social distancing, halting mass gatherings, voluntary quarantine, and testing.

It goes on to criticise the government's response to the crisis by stifling criticism and open discussion, saying, "at times, Prime Minister Narendra Modi's Government has seemed more intent on removing criticism on Twitter than trying to control the pandemic...with some state governments threatening those asking for oxygen or a hospital bed with national security laws."

Furthermore, it talks about how the success of any damage control measures will depend on how well India is able to restructure its response and whether the government is capable of "providing responsible leadership and transparency, and implementing a public health response that has science at its heart."

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